Medically underserved women are generally at higher risk for many health problems including cervical cancer. Solutions can often be found by utilizing resources within the community. An academic-community partnership has been formed to develop a novel approach to screening for cervical cancer. High risk types of human papillomavirus (HPV), 16, 18 and others, are etiologically linked to cervical cancer. HPV can be detected from samples obtained from self-swabbing of the vagina, urine testing, or insertion of tampons. These methods could be performed in the community or at home by women, which is useful for the group of women not visiting the gynecologist to receive recommended testing. This study will compare the effectiveness of home-based self sampling screening for cervical cancer with conventional Pap testing in a community-based setting. Given the ease of home use, it is hypothesized that home-based tampon testing for HPV DNA will be equal or superior to the annual Pap testing. For such home sampling to be effective, it must be: (1) used at least as much as current referral rates to the gynecologist; (2) acceptable to the woman as a means to prevent cervical cancer; (3) able to be performed at home; and (4) able to identify those women at risk for developing cervical cancer. The specific aims of this project are to: compare compliance with a home-sampling tampon HPV test to compliance with clinic Pap testing; assess a high risk population's acceptance of home use of a tampon for HPV testing in general and compared to traditional clinically administered Pap testing; assess a high risk population's ability to correctly follow instructions for home tampon sampling for HPV testing; and assess the accuracy of the home administered tampon HPV results. In order to achieve these aims, a group of women will be asked to administer the tampon sampling at home and return via mail. Another group will have conventional Pap testing for comparison. Surveys of satisfaction will also be conducted. PUBLIC HEALTH RELEVANCE: Because cervical cancer can be prevented through regular Papanicolaou (Pap) testing and follow-up with treatment of abnormal findings, the rates of cervical cancer have been dramatically reduced in the past decades; yet many women, particularly older women who no longer use gynecological services, do not receive the recommended testing which results in what would have been preventable cases of cervical cancer. Infection with human papillomavirus (HPV) is linked to cervical cancer and testing of HPV itself in a community setting offers another mechanism for preventing cervical cancer. Self-administered, home-based sampling for HPV testing is an opportunity to reach those women who are not visiting the gynecologist for cervical cancer screening.